Jackson, Nastassia S

Jackson, Nastassia S is an individual health care provider with primary practice located at 6830 W Villard Ave Ste 190 , Milwaukee WI 53218. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / School. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Jackson, Nastassia S can be contacted via phone (262) 320-7886.

Contact Information

Primary practice address
6830 W Villard Ave Ste 190 Milwaukee WI 53218
Phone: (262) 320-7886
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 2601 Wisconsin
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X
Behavioral Health & Social Service Providers / School 101YS0200X
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 7435 Wisconsin

Profile Details

NPI number 1720524341
LBN Legal business name Jackson, Nastassia S
Credentials LPC-IT
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 7th, 2017
Last updated Jun 18th, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720524341 NPPES
Wisconsin MEDICAID 100071680

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